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Student Psychological problems and dealing with Suicide November 2013 Dr V Wessels.

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Presentation on theme: "Student Psychological problems and dealing with Suicide November 2013 Dr V Wessels."— Presentation transcript:

1 Student Psychological problems and dealing with Suicide November 2013 Dr V Wessels

2 PSYCHOLOGICAL PROBLEMS: WHY STUDENTS? Pre-existing psychiatric diagnosis Environmental stressors –Finance –Social adapting –Workload Substance abuse Relationship issues Lack of support Immaturity – still finding themselves

3 QUICK DEPRESSION CHECK: PHQ 9 Over the last 2 weeks, how often have you been bothered by the following: Not at allSeveral daysMore thanhalf the daysNearly everyday Little interest or pleasure in doing things0123 Feeling down, depressed or hopeless0123 Trouble falling or staying asleep, or sleeping too much0123 Feeling tired or having little energy0123 Poor appetite or over eating0123 Feeling bad about yourself or that you are a failure and have let people down 0123 Trouble concentrating on things example watching tv or reading0123 Moving or speaking so slowly that others could have noticed, or the opposite, fidgety 0123 Thoughts that you would be better off dead, or that you would hurt yourself 0123

4 PHQ 9 Good tool for people not in the medical profession Score greater than 5: consider depression More than 4 ticks in 2 and 3 column (1 of which must be first or second question)

5 SUICIDE - STATS In South Africa there are 23 suicides a day, and 230 attempts 20% of students have had suicide thoughts 8% deaths in SA Highest cause of death in students second to accidents Poisoning / Overdose most frequent in unsuccessful attempts Hanging most common ins successful suicide, then shooting, gassing, burning, and jumping 90% of people that commit suicide have a psychiatric problem, 60% depressed

6 BE AWARE: WARNING SIGNS Talks about committing suicide/ death Has trouble eating or sleeping Big changes in behaviour Withdraws from friends or social activity Loses interest in work/ hobbies/ personal appearance Prepares for death by making a will or final arrangements Gives away prized possessions Has attempted suicide before Takes risks Has had severe loss recently

7 SUICIDE Everyone reacts to a traumatic event in their own way, and reactions can change from day to day, or even from moment to moment Suicide is an unpredictable event


9 PREVENTION Awareness Access to support –Formal (psychologists, Help Lines, Support groups) –Informal (extra-curricular activities / Sport, peer groups) Identify and modify stressors where possible Teach life skills

10 RESPONSE : UNSUCCESSFUL ATTEMPT Safety First (Fire arms, blades, heights, poisons) Remain calm and be assertive but not challenging Do not ridicule Do not lie (if at all possible) Seek medical treatment – if necessary involuntary within the scope of the Mental Health Care Act

11 EMERGENCY MANAGEMENT OF MENTAL ILLNESS TABLE 1 MAJOR SIGNS AND SYMPTOMS OF MENTAL ILLNESS Abnormal mood (inappropriately sad or happy) Confusion / disorientated Hallucinations Delusions Incoherent speech and strange behaviour not due to another identifiable medical reason Anxiety / agitation not due to another identifiable medical reason

12 EMERGENCY MANAGEMENT OF MENTAL ILLNESS TABLE 2 APPROPRIATE MENTAL HEALTH CARE FACILITIES All Provincial Hospital Emergency Units All Community Healthcare Centres Any clinic that has a trained Mental Health Care Practitioner

13 MENTAL HEALTH CARE ACT 17 OF 2002 32. A mental health care user must be provided with care, treatment and rehabilitation services without his or her consent at a health establishment on an outpatient or inpatient basis if- (a) an application in writing is made to the head of the health establishment concerned to obtain the necessary care, treatment and rehabilitation services and the application is granted; (b) at the time of making the application, there is reasonable belief that the mental health care user has a mental illness of such a nature that- (i) the user is likely to inflict serious harm to himself or herself or others; or (ii) care, treatment and rehabilitation of the user is necessary for the protection of the financial interests or reputation of the user; and (c) at the time of the application the mental health care user is incapable of making an informed decision on the need for the care, treatment and rehabilitation services and is unwilling to receive the care, treatment and rehabilitation required.

14 MENTAL HEALTHCARE ACT 17 OF 2002 33. Application to obtain involuntary care, treatment and rehabilitation 34. 72-Hour assessment and subsequent provision of further involuntary care, treatment and rehabilitation

15 EMERGENCY MANAGEMENT OF MENTAL ILLNESS Pt displays signs or symptoms of mental illness (see table 1) Pt resists or refuse treatment Pt an immediate danger to himself, others or property No management as an emergency mental health patient required Transport patient to appropriate Mental Healthcare facility (see table 2) Consult with SMO. Advise family to seek elective mental health care from the nearest appropriate Health Care Facility Request SAPS assistance. If pt armed do not approach until SAPS on scene SAPS on scene? YES NO

16 MANAGING THE VIOLENT PATIENT ENSURE THE SAFETY OF ALL STAFF INVOLVED AS WELL AS THE PATIENT AS FAR AS POSSIBLE Ensure patient is not armed. If armed, allow the SAPS to disarm the patient prior to any physical intervention by health care staff. Exclude reversible causes of aggression especially Hypoxia and pain Attempt to calm patient through friendly but assertive conversation. Do not insult or patient. Aggression / Violence resolved? NO YES

17 MANAGING THE VIOLENT PATIENT PHYSICAL RESTRAINT Staff members to remove spectacles and loose clothing items like ties. Ensure escape route (eg door) is behind staff and not the patient. Assign one person to each limb and one to the head. Restrain patient on his side preferably using strong leather restraints (do not use thin straps or material that can cut or chafe) Tie arms on the same side, but apart to avoid loosening. Tie legs to opposite sides. Do not partially restrain patient. Ensure access to an injection site Monitor patient – DO NOT leave unattended SEDATION Administer 1. Haloperidol 5mg PO / IMI / IVI and / or 2.. Lorazepam 0.5 - 4mg IMI / IVI or 3. Diazepam 10mg PO/ IVI or rectal Is ALS / Dr available with sedatives? TRANSPORT TO APPROPRIATE HEALTHCARE FACILITY Monitor patient regularly NO YES

18 RESPONSE : SUCCESSFUL ATTEMPT Safety First (Fire arms, blades, heights, poisons) Seek medical on scene asssessment - urgent (may be salveagable) Preserve evidence Activate law enforcement Notification –Authorities –Campus Management –Family Trauma Support –Responders –Friends and family –Anybody else who needs

19 TRAUMA : COMMON REACTIONS EXPERIENCED Emotional Responses Cognitive (Thoughts) Responses Behavioral Responses Physical Responses

20 EMOTIONAL RESPONSES Panic and fear Shock Highly anxious, active response or a seemingly stunned, emotionally- numb response Feeling as though he/she is in a fog Denial or inability to acknowledge the impact of the situation or that the situation has occurred Dissociation, in which he/she may seem dazed and apathetic May express feelings of unreality Intense feelings of aloneness Hopelessness Helplessness Emptiness Uncertainty Horror or terror Anger Hostility Irritability Depression Grief Feelings of guilt

21 COGNITIVE (THOUGHTS) RESPONSES Impaired concentration Confusion Disorientation Difficulty in making a decision A short attention span Vulnerability Forgetfulness Self-blame Blaming others Thoughts of losing control Hyper vigilance/very alert Recurring thoughts of the traumatic event

22 BEHAVIORAL RESPONSES Withdrawal spacing-out Non-communication Changes in speech patterns Regressive behaviours Erratic movements Impulsivity A reluctance to abandon property Seemingly aimless walking Pacing An inability to sit still An exaggerated startle response Antisocial behaviours

23 PHYSICAL RESPONSES Rapid heartbeat Elevated blood pressure Difficulty with breathing Shock symptoms Chest pains Cardiac palpitations Muscle tension and pains Fatigue Fainting Flushed face Pale appearance Chills Cold clammy skin Increased sweating Thirst Dizziness Vertigo Hyperventilation Headaches Grinding of teeth Twitches Gastrointestinal upset

24 FOUR MAIN GOALS IN CRISES COUNSELING To help the person cope effectively with the crisis situation and return to his or her usual normal level of functioning. To decrease the anxiety, apprehension and other insecurities that may be present during the crisis and after it passes. To teach crisis-management techniques so the person is better prepared to anticipate and deal with future crises. To help the client learn valuable life lessons through dealing with the trauma aftermath.

25 TRAUMA DEBRIEFING PHASES Introductory phase Fact Phase Feeling Phase Symptom Phase Teaching Phase Re-Entry Phase Closure Follow-up

26 CLOSURE Every person needs closure about events in their lives. Closure with trauma takes time and should be taken week for week. The coping skills will help with getting closure faster.


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